Affordable Care for All Americans

Yesterday the Supreme Court largely upheld the Affordable Care Act, and we can be sure that over the next few weeks, countless stories of Americans who have been affected by the ACA and the ruling will emerge. The voices of lesbian, gay, bisexual, and transgender (LGBT) Americans, who have long faced barriers in accessing adequate, affordable, and competent health care are crucial in this debate, and need to be heard. The health disparities facing LGBT Americans are daunting, and unequal access to health care is a roadblock to full equality. Yesterday's historic ruling ensures that the Affordable Care Act and its provisions will continue to positively affect the LGBT community.

Statistics show that only 57 percent of transgender Americans have health insurance, compared with approximately 82 percent of heterosexual adults and 77 percent of LGB adults. And as many as 2 million children living in LGBT families face significant challenges to accessing adequate health care as a result of bias, stigma, and barriers to access. The Obama administration understands these health disparities and has focused on remedying reduced access to affordable health care, restrictions on medical decision making, unwelcoming health-care environments, and increased health outcome disparities.

An unwelcoming or hostile health-care environment is a serious problem, with data showing that 29 percent of LGB adults and 48 percent of transgender adults delayed or never sought care for themselves. The ACA helps LGBT Americans and their families receive the health care that suits them by including provisions for data collection and research to better understand LGBT health disparities, prioritizing cultural competency and diversity for all health-care professionals, and by making it easier to find providers offering coverage for same-sex partners.

With the Patient's Bill of Rights, the ACA ends abuses by insurance companies that deny coverage based on preexisting conditions or put annual limits on coverage, which has a disproportionately adverse impact on HIV-positive and transgender patients. It also extends federal nondiscrimination protections to the health-care system, for the first time including protections for Americans living with disabilities and with HIV and AIDS. Additionally, the ACA benefits people living with HIV and AIDS by making prescription drugs more affordable.

Another barrier facing the LGBT community, and particularly transgender people, is high rates of unemployment and employment discrimination. Because we still do not have federal protections against discrimination in the workplace, transgender people face higher rates of termination, bias, and harassment, contributing to lower rates of employer-provided health-insurance coverage. Yesterday's ruling is a mixed bag, however, because while private insurance exchanges will include nondiscrimination provisions so that people cannot be denied on the basis of sexual orientation or gender identity, the ruling challenges the Medicaid expansion provision. We have a lot of work to do to continue to address the disparities facing not only LGBT people but Americans with lower incomes, and people of color who need Medicaid.

Preventive care is one of the touchstones of this landmark policy, and the impact on the health of the LGBT community is enormous. To address disparities, the ACA includes coverage of preventive care for Medicare beneficiaries, including HIV and STI testing, depression screening, vaccinations, tobacco-use screening, cholesterol and high-blood-pressure screening, and well-woman services.

For all these reasons, the Affordable Care Act is an essential step forward in closing LGBT health disparities.

In addition to the provisions outlined in the ACA, this administration and the Department of Health and Human Services has:

Issued an advance directive to fix hospital visitation issues to ensure that hospitals allow patients however the families are formed.

Addressed gaps in cultural competency with training programs.

Fund research that collects crucial data as it relates specifically to LGBT people and their families.

Added new features to healthcare.gov to allow individuals to find health plans that fit their needs, including coverage that will include same-sex spouses.

Relaunched stopbullying.gov to address bullying and the enormous impact it has on a young person's mental, emotional, and physical health.

While the Obama administration has done more for LGBT health than any other administration, we must continue to hold our leaders accountable, because even with yesterday's ruling, there is still a lot of work to be done at the federal level to address LGBT inequality.

First and foremost, DOMA must go. The so-called Defense of Marriage Act prevents the federal government from recognizing the marriages of gay and lesbian couples who are legally married in their home states. Because most employee benefits are regulated under the federal Employee Retirement Income Security Act (ERISA) and are subject to DOMA, employers are therefore not required to extend health-insurance benefits to the partners of LGBT employees or their partners' children. We also need to fight for the full implementation of this law and continued and expanded Medicaid coverage for those who are most vulnerable.

In the February 2012 White House Conference on LGBT Health, Secretary Sebelius said that one of the core principles that guides this administration is fairness. Yesterday's Supreme Court ruling upholds this very value and is a huge step forward in the fight for equality for LGBT Americans. The dream of being able to protect one's family and live a healthy life should not be a political football and is something every American should be able to access regardless of sexual orientation or gender identity. While the ACA goes a long way in addressing the numerous health disparities facing the LGBT community, we know that we have a long way to go.

So this is my promise: We will continue to fight even as we celebrate.